CT computed tomography

Transcription

1 CT computed tomography Tel: mg / 22 Klebsiella pneumoniae 4 CT computed tomography 4 2 CT Fig cm 51kg / 74mmHg 95 / 2 WBC 7530 / mm 3 Hb 7.4g / dl Ht / mm 3 GOT 53U / l GPT 31U / l LDH 183U / l AMY 66U / l CK 424U / l CK-MB 10U / l BUN 24mg / dl Cr 5.99mg / dl Na 136mEq / l 45

2 14 7 Fig. 1 An abdominal computed tomography scan showing a newly formed aneurysm in front of the abdominal aorta. Fig. 2 Preoperative selective angiography shows a saccular aneurysm of the superior mesenteric artery. K 3.5mEq / l Cl 100mEq / l Mg 2.1mg / dl Ca 8.4mg / dl P 3.5mg / dl CRP 12.3mg / dl X CT CT CT 3cm Fig. 1 Fig. 2 3 CT 19 CRP 1.4mg / dl Fig. 3 Fig. 3 Intraoperative examination shows a saccular aneurysm (arrow), which includes the orifices of the superior mesenteric artery (SMA) (arrow) and the celiac artery (CA) (arrow). Ao, aorta. 0.5mg / kg PCPS percutaneous cardiopulmonary support 2 2 PCPS 46

3 Fig. 4 Aorta with a saccular aneurysm is resected from the proximal side of the celiac artery (CA) to directly above the renal artery (RA). Both ends of the aorta were closed with sutures. The CA and superior mesenteric artery (SMA) were reconstructed with an autologous great saphenous vein graft (SVG). Fig. 5 Postoperative intravenous digital subtraction angiography shows that the venous graft from the aorta to celiac artery and the venous graft from the aorta to the superior mesenteric artery are both patent and that the right axillofemoral bypass is visible. Fig. 4 10mm 1 13 CT 21 2 Fig , AIDS acquired immune deficiency syndrome compromised host / 1000 / 10 compromised host 47

4 14 7 Stanley 4 50 compromised host 11, 12 13, Treitz Kocher , , 19, Wright, C. B., Schoepfle, W. J., Kurtock, S. B., et al.: Gastrointestinal bleeding and mycotic superior mesenteric aneurysm. Surgery, 92: 40-44, Friedman, S. G., Pogo, G. J. and Moccio, C. G.: Mycotic aneurysm of the superior mesenteric artery. J. Vasc. Surg., 6: 87-90, Stanley, J. C., Wakefield, T. W., Graham, L. M., et al.: Clinical importance and management of splanchnic artery aneurysms. J. Vasc. Surg., 3: , Greenfield, L. J.: Surgery, 3rd Ed., Philadelphia, 2001, Lippincott Williams & Wilkins, pp De Bakey, M. E. and Cooley, D. A.: Successful resection of mycotic aneurysm of superior mesenteric artery; Case report and review of literature. Am. Surg., 19: , Deterling, R. A.: Aneurysm of the visceral arteries. J. Cardiovasc. Surg., 12: , Gomes, M. N., Choyke, P. L. and Wallace, R. B.: Infected aortic aneurysms: A changing entity. Ann. Surg., 215: , Saitoh, H., Nakamura, K., Hida, M., et al.: Urinary tract infection in oliguric patients with chronic renal failure. J. Urol., 133: , Muraya, Y., Oozono, Y., Kadota, J., et al.: Clinical and immunological evaluation of infection in patients on hemodialysis. J. Infect. Chemother., 2: , Maisonnette, F., Thognon, P., Durand-Fontanier, S., et al.: Rupture of mesenteric artery branch aneurysm. Ann. Vasc. 48

5 Surg., 15: , Chao, S. H., Lin, F. Y. and Chen, K. M.: Aortomesenteric bypass using autogenous saphenous vein graft for superior mesenteric artery aneurysm: Report of a case. J. Formos. Med. Assoc., 89: , Zimmerman-Klima, P. M., Wixon, C. L., Bogey, W. M., et al.: Considerations in the management of aneurysms of the superior mesenteric artery. Ann. Vasc. Surg., 14: , An Infectious Aneurysm of the Superior Mesenteric Artery in a Patient Receiving Hemodialysis Hiromasa Yanagi 1, Kiyotaka Imoto 1, Sinichi Suzuki 1, Keiji Uchida 1, Naoki Hashiyama 1 and Yoshinori Takanashi 2 1 The Department of Cardiovascular Surgery, Yokohama City General Medical Center 2 The Department of Systematic Approach and Surgical Practice for Organ Disorder, Yokohama City University School of Medicine Key words: Hemodialysis, Steroid, Infectious aneurysm of the superior mesenteric artery, Great saphenous vein graft, Omentopexy A 65-year-old man who had received hemodialysis for 8 years was given steroids because of facial paralysis. Urinary tract infection and bacteremia caused by Klebsiella pneumoniae developed after 22 days. Four days later the patient had severe abdominal pain. Computed tomography and angiography revealed a saccular aneurysm of the superior mesenteric artery. He was intravenously given an antibiotic effective against K. pneumoniae. After inflammatory signs and symptoms resolved, blood culture examination became negative, and surgical treatment was indicated. A left anterolateral thoracotomy was performed through the seventh intercostal space and extended to an oblique incision of the left upper abdomen by hinging on the costal arch. A saccular aneurysm arose from the orifice of the superior mesenteric artery and spread from the surrounding aorta to the celiac artery. With the patient under partial extracorporeal circulation, the saccular aneurysm and the surrounding aorta were resected as one mass, which included the aorta from the origin of the celiac artery to the origin of the renal artery. Both ends of the aorta were closed with sutures. The superior mesenteric artery and celiac artery were each interposed to the abdominal aorta with autologous great saphenous vein grafts. A right axillofemoral bypass was reconstructed with a 10-mm prosthetic graft. The aorta and two vein grafts were covered with the greater omentum. The patient survived and has been followed up at the outpatient clinic with no particular problem, for 3 years and 4 months after operation. Jpn. J. Vasc. Surg., 14: ,